The Copenhagen City Heart Study, Copenhagen University Hospital-Frederiksberg, Copenhagen, Denmark.
Medical Department, Copenhagen University Hospital-Herlev, Herlev, Denmark.
Am J Respir Crit Care Med. 2021 Oct 15;204(8):910-920. doi: 10.1164/rccm.202102-0517OC.
Natural history of preserved ratio impaired spirometry (PRISm), often defined as FEV/FVC ⩾lower limit of normal and FEV <80% of predicted value, is not well described. To investigate the natural history and long-term prognosis of the following PRISm trajectories: persistent PRISm trajectory (individuals with PRISm both young and middle-aged), normal to PRISm trajectory (individuals developing PRISm from normal spirometry in young adulthood), and PRISm to normal trajectory (individuals recovering from PRISm in young adulthood by normalizing spirometry while middle-aged). We followed 1,160 individuals aged 20-40 years from the Copenhagen City Heart Study from 1976 to 1983 until 2001 to 2003 to determine their lung function trajectory; 72 had persistent PRISm trajectory, 76 had normal to PRISm trajectory, 155 had PRISm to normal trajectory, and 857 had normal trajectory. From 2001-2003 until 2018, we determined the risk of cardiopulmonary disease and death. We recorded 198 admissions for heart disease, 143 for pneumonia, and 64 for chronic obstructive pulmonary disease as well as 171 deaths. Compared with individuals with normal trajectory, hazard ratios for individuals with persistent PRISm trajectory were 1.55 (95% confidence interval, 0.91-2.65) for heart disease admission, 2.86 (1.70-4.83) for pneumonia admission, 6.57 (3.41-12.66) for chronic obstructive pulmonary disease admission, and 3.68 (2.38-5.68) for all-cause mortality. Corresponding hazard ratios for individuals with normal to PRISm trajectory were 1.91 (1.24-2.95), 2.74 (1.70-4.42), 7.61 (4.21-13.72), and 2.96 (1.94-4.51), respectively. Prognosis of individuals with PRISm to normal trajectory did not differ from those with normal trajectory. PRISm in middle-aged individuals is associated with increased risk of cardiopulmonary disease and all-cause mortality, but individuals who recover from PRISm during their adult life are no longer at increased risk.
保留的比值受损肺活量测定（PRISm）的自然史，通常定义为 FEV/FVC ⩾正常下限和 FEV <80%的预计值，尚未得到很好的描述。为了研究以下 PRISm 轨迹的自然史和长期预后：持续的 PRISm 轨迹（年轻人和中年人都有 PRISm 的个体）、从正常肺活量测定发展为 PRISm 的正常到 PRISm 轨迹（年轻人时从正常肺活量测定发展为 PRISm 的个体）和 PRISm 到正常轨迹（中年人时通过正常化肺活量测定从 PRISm 恢复的个体）。我们从 1976 年至 1983 年的哥本哈根城市心脏研究中随访了 1160 名 20-40 岁的个体，直到 2001 年至 2003 年，以确定他们的肺功能轨迹；72 名个体有持续的 PRISm 轨迹，76 名个体有正常到 PRISm 轨迹，155 名个体有 PRISm 到正常轨迹，857 名个体有正常轨迹。从 2001 年至 2003 年至 2018 年，我们确定了心肺疾病和死亡的风险。我们记录了 198 例心脏病入院、143 例肺炎入院和 64 例慢性阻塞性肺疾病入院以及 171 例死亡。与正常轨迹个体相比，持续 PRISm 轨迹个体的心脏病入院危险比为 1.55（95%置信区间，0.91-2.65），肺炎入院危险比为 2.86（1.70-4.83），慢性阻塞性肺疾病入院危险比为 6.57（3.41-12.66），全因死亡率危险比为 3.68（2.38-5.68）。正常到 PRISm 轨迹个体的相应危险比分别为 1.91（1.24-2.95）、2.74（1.70-4.42）、7.61（4.21-13.72）和 2.96（1.94-4.51）。PRISm 到正常轨迹个体的预后与正常轨迹个体没有差异。中年个体的 PRISm 与心肺疾病和全因死亡率风险增加相关，但在成年后从 PRISm 中恢复的个体不再面临更高的风险。
